Abstract
BackgroundPopulation health intervention research raises major conceptual and methodological issues. These require us to clarify what an intervention is and how best to address it.This paper aims to clarify the concepts of intervention and context and to propose a way to consider their interactions in evaluation studies, especially by addressing the mechanisms and using the theory-driven evaluation methodology.Main textThis article synthesizes the notions of intervention and context. It suggests that we consider an “interventional system”, defined as a set of interrelated human and non-human contextual agents within spatial and temporal boundaries generating mechanistic configurations – mechanisms – which are prerequisites for change in health. The evaluation focal point is no longer the interventional ingredients taken separately from the context, but rather mechanisms that punctuate the process of change. It encourages a move towards theorization in evaluation designs, in order to analyze the interventional system more effectively. More particularly, it promotes theory-driven evaluation, either alone or combined with experimental designs.ConclusionConsidering the intervention system, hybridizing paradigms in a process of theorization within evaluation designs, including different scientific disciplines, practitioners and intervention beneficiaries, may allow researchers a better understanding of what is being investigated and enable them to design the most appropriate methods and modalities for characterizing the interventional system. Evaluation methodologies should therefore be repositioned in relation to one another with regard to a new definition of “evidence”, repositioning practitioners’ expertise, qualitative paradigms and experimental questions in order to address the intervention system more profoundly.
Highlights
This article synthesizes the notions of intervention and context
Evaluation methodologies should be repositioned in relation to one another with regard to a new definition of “evidence”, repositioning practitioners’ expertise, qualitative paradigms and experimental questions in order to address the intervention system more profoundly
In light of the above, we propose to define the interventional system in population health intervention research as: A set of interrelated human and non-human contextual agents within spatial and temporal boundaries generating mechanistic configurations – mechanisms – which are prerequisites for change in health
Summary
To clarify the notions of intervention, context and system What is an intervention? According to the International Classification of Health Interventions (ICHI), “a health intervention is an act performed for, with or on behalf of a person or population whose purpose is to assess, improve, maintain, promote or modify health, functioning or health conditions”. What is validated (or not) is the extent to which the explanatory theory, including implementation parameters (unlike realist evaluation), corresponds to observations: expected change (i.e. 30 mins of daily physical activity); presence of individual or socio-ecological prerequisites for success (i.e. access to appropriate facilities, sufficient physical ability, knowledge about the meaning of physical activity, etc.) based on psychosocial or organizational theories (e.g. social cognitive theory, health belief model) called classic theories [31]; effectivity of actions to achieve the prerequisites for change (i.e. types of intervention or necessary environmental modifications and their effects) based on implementation theories [31] (e.g COM-B model: Capacity-Opportunity-Motvation – Behaviour Model).; effectivity of actions conducive to these prerequisites (i.e. use of the necessary intellectual, human, financial and organizational (...) resources). The TC-REG project [28] has held a seminar involving both prevention practitioners and researchers, the aim being to discuss literature results and different theories/frameworks in order to define the explanatory theory (with context-mechanism configurations) and intervention strategies to be planned to test it
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